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My BPD dd19 is away at college out of state.  I do not like the current psychiatrist, plus our insurance is giving us a hard time so I was able to explain that to dd and convince her we need a change.  I've been doing a ton of research, asking around, speaking with doctors.  Here's my issue: I can see a HUGE difference between doctors. We are in the tri-state where we have access to some of the best doctors in the world.  There are some psychiatrists I've spoken with who don't ask to speak with previous providers, don't have a website where I can read about their background and training, don't ask to speak with the family, and the patients are in and out in 30 mins.  I've spoken with other psychiatrists (who are also specialists in psychpharmacology) who ask me detailed questions, meet with us, then our BPD dd, then all of us together.  Basically they are offering a 4.5-5 hour initial evaluation, then monthly or every month visits. Those dr's asked for neuropscyh eval and any other testing, the others didn't.

My gut tells me we need the second type of dr, but my husband will FREAK out when I tell him the cost.  I can keep the fees to myself and hope he doesn't find out...(please don't judge, marriage/money/mental health is complicated AF).  The second type of drs seem to be the "in charge" of the situation type, wanting to talk to the therapist regularly and keep the family involved.  To give an example, one dr (the 30 mins type) was very nice on the phone, but when I told her on the initial call I only had 5 minutes to talk, she said she only needed 2mins.  Made an appointment for my DD in a few weeks and that's it. No additional history or investigation.  The second one (4-5hr eval) spoke with me for about 15 minutes and her first question when I explained her diagnosis, was "is your dd a good historian and reporter?"  the answer is no, my dd is not an accurate reporter and sees everything through her BPD glasses.  The fact that this dr asked me that-that she knew BPD kids skew their views of their surroundings-makes me think she will be more likely to smell the BS my dd spews.

BUT THE COST is $$$$$$ crazy expensive.  As I said , I can swing it, not easily or happily, but I don't want to chose the cheaper path. 

Can anyone give me some thoughts on the type of psychiatrists your kids see?

Hello Smile Pretty. Welcome to the group. I can see you have a lot on your plate right now as you help your daughter get what she needs. My DS24XBPD refuses treatment so where to get treatment is a moot point right now. If he was amenable to seeing a psychotherapist or psychiatrist we would have to go through insurance via the mental health/ substance abuse hotline. I have gotten good referrals this way.

Hi smilepretty

Gosh that sounds like a hard decision. I'm in the UK and with our National Health System (NHS) we pay for through our taxes there is no choice, you work with who you are given, if you don't like it you go private and pay. That said, NHS are responsible for setting the acceptable standard of service, regulated and I'm wondering if what FHLKC refers to is the equivalent. One thing I can share is continuity has been important to my DD she's been with her psychiatrist (who I've never met) since crisis, diagnosis in 2015. From my experience it's about building a relationship of trust and openness, what's working, what's not, it's been a slow though very successful process. I'm wondering what you do not like about the current psychiatrist? How long has your DD been seeing them. If they specialise in personality disorders they'll be conversant with your DD's behaviours?

Profile is Consultant Psychiatrist and Psychotherapist at a NHS Foundation Trust where they are joint clinical lead for the personality disorder service. Is involved in research projects related to the functioning of the brain in mental disorders, ardent educator, has a lead role in teaching medical students and psychiatrists at both the Trust and universities. Also works in private practice.

Last week my DD tried to arrange an appointment and was told she's no longer eligible to see a psychiatrist under the NHS mental health service.  :(  
Anyhow we've tracked his private practice and DD's waiting for an appointment, going by the street address it ain't going to be cheap either... though because it's not a new assessment and say 2-3 appointments a year it's likely great value for money. I don't recall my DD having tests you refer to.

I hope sharing my experience though not US is helpful for you and others. It's good to talk about as I felt lost in 2015/16 not knowing what's ahead. How might you feel if a psychiatrist asked you to step back so they can work with your adult DD? It's her responsibility to put in the work if she's ready. Took my DD till 26 to engage. Last year I asked why she did not reach out to help herself earlier, she said she was not ready to face despite knowing things were not right, she continued with her studies, work and became more ill as time progressed. She's now finding a life that works for her and it's taking a lot of learning on her part, she's moving in the right direction at her pace 4 years in.

Thanks for posting SP we all struggle with knowing if our children are getting the treatment they need when they are ready to engage, I completely get where you are.

Small steps, things do get better.

WDx

Dear smilepretty:

I would pick a doctor from the 2nd group. It sounds like she would get better care. As with a lot of things, "you get what you pay for".

Sorry about the "crazy expensive" part. Maybe you could ask if they happen to have a sliding fee schedule or a payment plan. We have a Care Credit Card, which can only be used at certain places. However if you charge over a certain amount, you get free interest if you pay it off in a specified time period.

Currently, our son sees a local psychiatrist that participates with our insurance plan.  However, sometimes it has taken that office 4 days to return our calls about a medication change. Unfortunately, there's only 3 to 5 psychiatrist's in our town of 28,000 people. 

We have an appointment out of town for a different psychiatrist that specializes in BPD. Insurance won't copy as well, plus 3 hour round trip travel time. Not to mention that DS's therapist told him that he only has anxiety & not BPD.  Definitely time for a second opinion! 

Good luck & stay in touch!

Hi Smilepretty,

I think you answered your own question, you DON'T want to choose the cheaper path. The question this lady asked really shows that she understands BPD folks. We've been pretty lucky with the psychiatrist's so far, all of them have asked for her previous evaluations, med history, etc. They have also met with my daughter and I both separately and together. My daughter is 16, so they are still able to give me overviews of what's going on, obviously without stepping over the confidentiality line, which helps me to help her. But we had a really bad therapist who obviously hadn't worked with BPD patients before, (See my previous threads) so I have become leary of professionals who don't have the proper background for dealing with BPD patients.

Our current therapist isn't on our plan, so I'm paying the full cost out of pocket. While I'd love to be spending less money, I'm seeing improvements in my daughter's mental health, so I don't mind as much.

As Stampingt1 pointed out, maybe you could work something out with the psychiatrist? A lot of time they give a discount when you're paying cash, or maybe they can arrange a deal for you.

It never hurts to ask.

Good luck!

Thanks everyone. I corresponded with a BPD therapist that I took my non BPD dd to (to help deal with her sister) and I liked her very much so I thought she could help and she did.  She recommended a specialized psychiatrist (group 2) for the type of situation we are in AND gave me her opinion of a few of the doctors I researched AND gave me the name of someone else. This therapist is proving to be a great resource so I feel like i am on the right path!

smilepretty:

Great! Glad that you had a good session & received the name of someone that might be able to help.

Stampingt1

Hi smilepretty

  I join St1  Relief   I'm so pleased you've connected, have a forward network to explore.  Your research, experience helps so many reading your thread.

Research, my DD shared a 20 page document compiled by a health worker,  of low, no cost access to a wide range of social services in our borough and wider, people in need can access. That is the challenge for so many, finding the way, there is help out there.

WDx